Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Choosing a safe and successful weight-loss program
Scientists have made tremendous strides in understanding obesity and in improving the medication treatment of this important disease. In time, better, safer, and more effective obesity medications will be available. But currently there is still no "magic cure" for obesity. The best and safest way to lose fat and keep it off is through a commitment to a life-long process of proper diet and regular exercise. Medications should be considered helpful adjuncts to diet and exercise for patients whose health risk from obesity clearly outweigh the potential side effects of the medications. Medications should be prescribed by doctors familiar with the patients' conditions and with the use of the medications. Medication(s) and other "herbal" preparations with unproven effectiveness and safety should be avoided.
Almost any of the commercial weight-loss programs can work, but only if they
motivate you sufficiently to decrease the amount of calories you eat or increase
the amount of calories you burn each day (or both). What elements of a
weight-loss program should a consumer look for in judging its potential for safe
and successful weight loss? A responsible and safe weight-loss program should be
able to document for you the five following features:
The diet should be safe. It should include all of the recommended daily
allowances (RDAs) for vitamins, minerals, and protein. The weight-loss diet
should be low in calories (energy) only, not in essential foodstuffs.
The weight-loss program should be directed toward a slow, steady weight loss
unless your doctor feels your health condition would benefit from more rapid
weight loss. Expect to lose only about a pound a week after the first week or
two. With many calorie-restricted diets there is an initial rapid weight loss
during the first one to two weeks, but this loss is largely fluid.
If you plan to lose more than 15 to 20 pounds, have any health problems,
or take medication on a regular basis, you should be evaluated by your doctor
before beginning your weight-loss program. A doctor can assess your general
health and any medical conditions that might be affected by dieting and weight
loss. Also, a physician should be able to advise you on the need for weight
loss, the appropriateness of the weight-loss program, and a sensible goal of
weight loss for you. If you plan to use a very low-calorie diet (a special
liquid formula diet that replaces all food intake for one to four months), you should
do so under the close supervision of a health care practitioner.
Your program should include plans for weight maintenance after the weight
loss phase is over. It is of little benefit to lose a large amount of weight
only to regain it. Weight maintenance is the most difficult part of controlling
weight and is not consistently implemented in weight-loss programs. The program
you select should include help in permanently changing your dietary habits and
level of physical activity, and to alter a lifestyle that may have contributed
to weight gain in the past. Your program should provide behavior modification
help, including education in healthy eating habits and long-term plans to deal
with weight problems. One of the most important factors in maintaining weight
loss appears to be increasing daily physical activity. Try to be more active
throughout the day and incorporate some simple calorie-burners into your
everyday routine. Even the most basic activities (such as taking an after-dinner
walk, using the stairs at the mall or office instead of taking an escalator or
elevator, park your car farther away so you have a longer walk) can get you
prepared for more regular exercise like walking or jogging. You may choose to
incorporate an individually tailored exercise program into your schedule.
A commercial weight-loss program should provide a detailed statement of
fees and costs of additional items such as dietary supplements.
Obesity is a chronic condition. Too often it is viewed as a temporary problem
that can be treated for a few months with a strenuous diet. However, as most
overweight people know, weight control must be considered a life-long effort. To
be safe and effective, any weight-loss program must address the long-term
approach or else the program is largely a waste of time, money, and energy.
Conclusion
Maintaining your ideal body weight is a balancing act between food
consumption and calories needed by the body for energy. You are what you eat.
The kinds and amounts of food you eat affect your ability to maintain your ideal
weight and to lose weight.
Medical science has established that eating proper foods can influence health
for all age groups. The U.S. Department of Agriculture's current dietary
guidelines state:
Eat a variety of foods.
Balance the food you eat with physical
activity--maintain or improve your weight.
Choose a diet with plenty of grain
products, vegetables, and fruits.
Choose a diet low in fat, saturated fat, and
cholesterol.
Choose a diet moderate in sugars.
Choose a diet moderate in salt
and sodium.
If you drink alcoholic beverages, do so in moderation.
Obesity At A Glance
Obesity means having excess body fat. For adults 35 and older, having a BMI greater
than 30 is considered obese.
Obesity is not just a cosmetic consideration. It is a chronic medical
disease that can lead to diabetes, high blood pressure, heart disease,
gallstones, and other chronic illnesses.
Obesity is difficult to treat and has a high relapse rate. Greater than
95% of those who lose weight regain the weight within five years.
Even though medications and diets can help, the treatment of obesity
cannot be a short-term "fix" but has to be a life-long commitment to
proper diet habits, increased physical activity, and regular exercise.
The goal of treatment should be to achieve and maintain a "healthier
weight", not necessarily an ideal weight.
Even a modest weight loss of 5% to 10% of initial weight and the long-term
maintenance of that weight loss can bring significant health benefits by
lowering blood pressure and lowering the risks of diabetes and heart disease.
Chances of long-term successful weight loss are enhanced if the doctor
works with a team of professionals including dietitians, psychologists, and
exercise professionals.
REFERENCES:
National Institutes of Health (NIH); "Classification of
Overweight and Obesity by BMI, Waist Circumference, and Associated Disease
Risks." "Body Mass Index Table."
Manson JE, Colditz GA, Stampfer MJ, Willett WC, Rosner B, Monson RR, Speizer FE, Hennekens CH.; "A prospective study of obesity and risk of coronary heart disease in women." N Engl J Med. 1990 Mar 29;322(13):882-9.
W. B. Droyvold, T. I. Lund Nilsen, S. Lydersen, K. Midthjel, P. M. Nilsson, J.-Å. Nilsson, J. Holmen; "Weight change and mortality: the Nord-Trondelag Health Study."
Journal of Internal Medicine. Volume 257 Issue 4, Pages 338 - 345
National Center for Health Statistics; "National Health and
Nutrition Examination Survey." http://www.cdc.gov/nchs/nhanes.htm.
World Health Organization; "Global Database on Body Mass
Index."
Life Measurements, Inc. (www.bodpod.com)
United States National Library of Medicine, National
Institutes of Health; "Bioelectric Impedance Analysis in Body Composition Measurement."
Lars Sjöström, M.D., Ph.D., Anna-Karin Lindroos, Ph.D., Markku Peltonen, Ph.D., Jarl Torgerson, M.D., Ph.D., Claude Bouchard, Ph.D., Björn Carlsson, M.D., Ph.D., Sven Dahlgren, M.D., Ph.D., Bo Larsson, M.D., Ph.D., Kristina Narbro, Ph.D., Carl David Sjöström, M.D., Ph.D., Marianne Sullivan, Ph.D., Hans Wedel, Ph.D.. "Lifestyle, Diabetes, and Cardiovascular Risk FActors 10 Years after Bariatric Surgery." New England Journal of Medicine.
Volume 351:2683-2693, December 23, 2004.
U.S. Department of Health and Human Services, U.S.
Department of Agriculture; "Dietary Guidelines for Americans."
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Gout is a condition that results from crystals of uric acid depositing in tissues of the body. Gout is a condition that can lead to abnormally elevated levels of uric acid in the
blood, recurring attacks of joint inflammation (arthritis), deposits of
hard lumps of uric acid in and around the joints, and decreased kidney
function and kidney stones.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
A skin tag is a small benign growth of skin that projects from the surrounding skin. Skin tags can vary in appearance (smooth, irregular, flesh colored, dark pigment, raised). Skin tags generally do not cause symptoms unless repeatedly irritated. Treatment for skin tag varies depending on the location on the body.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Though the cause of stomach cancer is unknown, risk factors for stomach cancer include diet, H. pylori infection, smoking age, gastritis, stomach surgery, family history, and pernicious anemia. Symptoms include stomach discomfort, feeling full after a small meal, nausea and vomiting, and weight loss. Treatment depends upon staging and may involve surgery, radiation therapy, or chemotherapy.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
There are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
Carpal tunnel syndrome is a condition in which irritation of the wrist's median nerve causes tingling and numbness of the thumb, index, and the middle fingers. This condition is known as tarsal tunnel syndrome in the ankles and feet. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the nature of any disease that might be causing the symptoms.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Snoring, like all other sounds, is caused by vibrations that cause particles in the air to form sound waves. While we are asleep, turbulent air flow can cause the tissues of the nose and throat to vibrate and give rise to snoring. Any person can snore. Snoring is believed to occur in anywhere from 30% of women to over 45% of men. People who snore can have any body type. In general, as people get older and as they gain weight, snoring will worsen. Snoring can be caused by a number of things, including the sleep position, alcohol, medication, anatomical structure of the mouth and throat, stage of sleep, and mouth breathing.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
A pilonidal cyst is a cyst that forms near the cleft of the buttocks. The cysts are thought to be caused by the penetration of loose hairs into the skin. Symptoms and signs include pain, swelling, redness, warmth, and drainage of pus from the area of the cyst. Treatment of a pilonidal cyst involves incision and drainage.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
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